Compartment Syndrome

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Clinical Description

Condition where the Osseo fascial compartment pressure rises to a level that decreases perfusion to the limb and may lead to irreversible muscle and neurovascular damage. Diagnosis is made with the presence of severe and progressive limb pain that worsens with passive motion. Compartment syndrome may occur anywhere that skeletal muscle is surrounded by fascia.

Causes

• High energy trauma, burns
• Tight casts, dressings, or external wrappings
• Extravasation of IV infusion
• Post-ischemic swelling
• Bleeding disorders and arterial injury

Clinical Features

SIGNS AND SYMPTOMS

• Pain out of proportion to the clinical situation is usually the first symptom

INVESTIGATIONS

On Physical examination

• Pain on passive stretch of the compartment
• Paresthesia and hypoesthesia
• Paralysis*
• Palpable swelling*
• Peripheral pulses absent*

Late signs

• Clinical diagnosis but imaging required to rule out fracture

Treatment

Non operative

• Observation and limb elevation
• Bivalving the cast and loosening circumferential dressings

Operative

• Emergent fasciotomy of all limb compartments